|
Name |
Type |
Discontinued? |
|
1 |
COVERAGE_ID |
NUMERIC |
No |
|
|
|
The unique ID assigned to the coverage record. This ID may be encrypted if you have elected to use enterprise reporting’s encryption utility. |
|
|
2 |
COVERAGE_TYPE_C_NAME |
VARCHAR |
No |
|
|
|
The category value that indicates whether a coverage is managed care or indemnity; 1 – Indemnity, 2 – Managed Care. |
May contain organization-specific values: No |
Category Entries: |
Indemnity |
Managed Care |
|
|
3 |
PAYOR_ID_PAYOR_NAME |
VARCHAR |
No |
|
|
|
|
4 |
PLAN_ID_BENEFIT_PLAN_NAME |
VARCHAR |
No |
|
|
|
The name of the benefit plan record. |
|
|
5 |
PLAN_GRP_ID |
VARCHAR |
No |
|
|
|
The ID of the employer group that determines the benefits in a managed care coverage. This item is NULL for indemnity coverages. |
|
|
6 |
PLAN_GRP_ID_PLAN_GRP_NAME |
VARCHAR |
No |
|
|
|
The name of the employer group record |
|
|
7 |
COBRA_STATUS_YN |
VARCHAR |
No |
|
|
|
This yes/no flag is set to “Y” if the coverage has been extended beyond termination of the subscriber’s employment according to a COBRA arrangement. If the coverage has not been extended under such an arrangement, this value is “N” or null. |
May contain organization-specific values: No |
Category Entries: |
Yes |
No |
|
|
8 |
COBRA_DATE |
DATETIME |
No |
|
|
|
The termination date for any COBRA arrangement. |
|
|
9 |
LATE_ENROLL_YN |
VARCHAR |
No |
|
|
|
Y if the subscriber applied for coverage outside of the open enrollment period. N or NULL if not specified as a late enrollment coverage. |
May contain organization-specific values: No |
Category Entries: |
Yes |
No |
|
|
10 |
STUDENT_REVIEW_DT |
DATETIME |
No |
|
|
|
The date on which you should review the status of any members on this coverage who are students. |
|
|
11 |
EPIC_CVG_ID |
NUMERIC |
No |
|
|
|
The unique ID of the coverage record. This column may be hidden if you have elected to use enterprise reporting’s security utility. |
|
|
12 |
PB_ACCT_ID |
VARCHAR |
No |
|
|
|
The unique ID of premium billing account associated with the coverage. |
|
|
13 |
CVG_EFF_DT |
DATETIME |
No |
|
|
|
The effective date of the coverage. |
|
|
14 |
CVG_TERM_DT |
DATETIME |
No |
|
|
|
The termination date of the coverage. |
|
|
15 |
CASEHEAD_NUMBER |
VARCHAR |
No |
|
|
|
The Medicaid ID number on the case head. |
|
|
16 |
CASEHEAD_NAME |
VARCHAR |
No |
|
|
|
The Medicaid name on the case head. |
|
|
17 |
TNSFRD_COVERAGE_ID |
NUMERIC |
No |
|
|
|
The ID of the coverage from which this coverage is transferred from. |
|
|
18 |
CVG_REG_STATUS_C_NAME |
VARCHAR |
No |
|
|
|
The verification status of the coverage, such as verified, changed, elapsed, etc. |
May contain organization-specific values: Yes |
|
|
19 |
VERIFY_USER_ID |
VARCHAR |
No |
|
|
|
The ID of the user who performed the verification. |
|
|
20 |
VERIFY_USER_ID_NAME |
VARCHAR |
No |
|
|
|
The name of the user record. This name may be hidden. |
|
|
21 |
GROUP_NAME |
VARCHAR |
No |
|
|
|
The name of the coverage group. |
|
|
22 |
CVG_ADDR1 |
VARCHAR |
No |
|
|
|
The first line of the address of the coverage (administrative offices). |
|
|
23 |
CVG_ADDR2 |
VARCHAR |
No |
|
|
|
The second line of the address of the coverage (administrative offices). |
|
|
24 |
CVG_CITY |
VARCHAR |
No |
|
|
|
The city of the mailing address of the coverage (administrative offices). |
|
|
25 |
CVG_ZIP |
VARCHAR |
No |
|
|
|
The zip code of the mailing address of the coverage (administrative offices). |
|
|
26 |
CVG_PHONE1 |
VARCHAR |
No |
|
|
|
The primary phone number of the coverage (administrative offices). |
|
|
27 |
GROUP_NUM |
VARCHAR |
No |
|
|
|
The identification number assigned to this subscriber's employer/plan group by the payor. This number will appear in box 11 of the HCFA claim form. |
|
|
28 |
CLAIM_MAIL_CODE_C_NAME |
VARCHAR |
No |
|
|
|
The category value associated with where to send the claim on a coverage (i.e. send claim to payor, send claim to account, etc.) |
May contain organization-specific values: No |
Category Entries: |
Payer |
Account |
Payer Plan |
Coverage Address |
|
|
29 |
WC_EMPLOYER_ID |
VARCHAR |
No |
|
|
|
Workers' compensation employer at the time of injury. |
|
|
30 |
WC_EMPLOYER_ID_EMPLOYER_NAME |
VARCHAR |
No |
|
|
|
The name of the employer. |
|
|
31 |
WC_DATE_OF_INJURY |
DATETIME |
No |
|
|
|
Workers Comp date of injury. This is the date the injury occurred on the job. This field is populated as the user sets up the WC account. |
|
|
32 |
IS_SIG_ON_FILE_YN |
VARCHAR |
No |
|
|
|
Appears in Box 12 of HCFA claims. This is a Yes/No field that denotes whether authorization has been obtained to send bill or other documentation to payor for services relating to the claim. |
May contain organization-specific values: No |
Category Entries: |
Yes |
No |
|
|
33 |
ENROLL_REASON_C_NAME |
VARCHAR |
No |
|
|
|
This category value stores the enrollment reason of the coverage. |
May contain organization-specific values: Yes |
|
|
34 |
CVG_TERM_REASON_C_NAME |
VARCHAR |
No |
|
|
|
This category value stores the termination reason of the coverage. |
May contain organization-specific values: Yes |
|
|
35 |
PAT_REC_OF_SUBS_ID |
VARCHAR |
No |
|
|
|
If the subscriber is the same person as a patient, this item contains the patient ID. |
|
|
36 |
ECD_TABLE_DEF_COPAY |
NUMERIC |
No |
|
|
|
Numeric default copay value. |
|
|
37 |
COINSURANCE_OVR |
NUMERIC |
No |
|
|
|
Numeric Value for the coverage level coinsurance override. |
|
|
38 |
MEDC_COVERED_LEFT |
NUMERIC |
No |
|
|
|
This is the number of Medicare Covered Days Remaining |
|
|
39 |
MEDC_COINS_LEFT |
NUMERIC |
No |
|
|
|
This is the number of Medicare Coinsurance Days Remaining |
|
|
40 |
MEDC_RESERVE_LEFT |
NUMERIC |
No |
|
|
|
This is the number of Medicare Reserved Days Remaining |
|
|
41 |
CCS_PAT_ID |
VARCHAR |
No |
|
|
|
The patient's Comprehensive Community Services (CCS) ID. |
|
|
42 |
CCS_DX |
VARCHAR |
No |
|
|
|
Stores the diagnosis that makes the patient eligible for Comprehensive Community Services (CCS) coverage. |
|
|
43 |
CCS_CC_NAME |
VARCHAR |
No |
|
|
|
Stores the name of the Comprehensive Community Services (CCS) Case Coordinator. |
|
|
44 |
CCS_COOR_PHONE |
VARCHAR |
No |
|
|
|
Stores the phone number for the Comprehensive Community Services (CCS) Case Coordinator. |
|
|
45 |
CCS_COUNTY_PHONE |
VARCHAR |
No |
|
|
|
Stores the phone number for the Comprehensive Community Services (CCS) County Office. |
|
|
46 |
CVG_COUNTY_C_NAME |
VARCHAR |
No |
|
|
|
The county of the mailing address of the coverage (administrative offices). |
May contain organization-specific values: Yes |
|
|
47 |
CVG_COUNTRY_C_NAME |
VARCHAR |
No |
|
|
|
The country of the mailing address of the coverage (administrative offices). |
May contain organization-specific values: Yes |
|
|
48 |
CVG_HOUSE_NUM |
VARCHAR |
No |
|
|
|
The house number of the mailing address of the coverage (administrative offices). |
|
|
49 |
CVG_DISTRICT_C_NAME |
VARCHAR |
No |
|
|
|
The district of the mailing address of the coverage (administrative offices). |
May contain organization-specific values: Yes |
|
|
50 |
EFF_HOSP_CVG_DT |
DATETIME |
No |
|
|
|
The effective date of Medicare Part A. |
|
|
51 |
EFF_PROV_CVG_DT |
DATETIME |
No |
|
|
|
The effective date of Medicare Part B. |
|
|
52 |
MEDICARE_CVG_TYPE_C_NAME |
VARCHAR |
No |
|
|
|
The category number for the type of Medicare coverage the patient has. |
May contain organization-specific values: No |
Category Entries: |
Part A |
Part B |
Parts A & B |
|
|
53 |
Q4CO_BUCKETS_EXC_YN |
VARCHAR |
No |
|
|
|
Flag to indicate if bucket limits exceeded during carryover |
May contain organization-specific values: No |
Category Entries: |
Yes |
No |
|
|
54 |
MED_SEC_TYPE_C_NAME |
VARCHAR |
No |
|
|
|
Medicare Secondary Insurance Type Code. |
May contain organization-specific values: No |
Category Entries: |
Working Aged Beneficiary or Spouse with EGHP |
ESRD Beneficiary in the Mandated Coordination Period with an EGHP |
No-fault Insurance Including Auto is Primary |
Worker's Compensation |
Public Health Service (PHS) or Other Federal Agency |
Black Lung |
Veteran's Administration |
Disabled Beneficiary Under Age 65 with Large Group Health Plan (LGHP) |
Other Liability Insurance is Primary |
|
|
55 |
CHDP_COUNTY_C_NAME |
VARCHAR |
No |
|
|
|
The Child Health and Disability Prevention County Code. |
The category values for this column were already listed for column: CVG_COUNTY_C_NAME |
|
|
56 |
CHDP_AID_CODE |
VARCHAR |
No |
|
|
|
The Child Health and Disability Prevention Aid Code. |
|
|
57 |
CVG_CARD_ISSUE_DT |
DATETIME |
No |
|
|
|
Stores the card issue date. |
|
|
58 |
CVG_DEDUCTIBLE_YN |
VARCHAR |
No |
|
|
|
This item will serve as a flag to let the end user know if the response has any deductible information |
May contain organization-specific values: No |
Category Entries: |
No |
Yes |
|
|
59 |
FIRST_SPEC_AID_CODE |
VARCHAR |
No |
|
|
|
First special aid code for the Treatment Authorization Request (TAR) for Medi-Cal. |
|
|
60 |
SEC_SPEC_AID_CODE |
VARCHAR |
No |
|
|
|
Second special aid code for the Treatment Authorization Request (TAR) for Medi-Cal. |
|
|
61 |
THRD_SPEC_AID_CODE |
VARCHAR |
No |
|
|
|
Third special aid code for the Treatment Authorization Request (TAR) for Medi-Cal. |
|
|
62 |
EVC_NUM |
VARCHAR |
No |
|
|
|
Eligibility Verification Confirmation (EVC) that is used on the Treatment Authorization Request (TAR) for Medi-Cal. |
|
|
63 |
COUNTY_CODE_C_NAME |
VARCHAR |
No |
|
|
|
This item will store the county code that is returned from the 271 message. |
May contain organization-specific values: Yes |
No Entries Defined |
|
|
64 |
EXT_ROUTING_NUM_C_NAME |
VARCHAR |
No |
|
|
|
The external routing number for the coverage |
May contain organization-specific values: Yes |
No Entries Defined |
|
|
65 |
SUBSCR_OR_SELF_MEM_PAT_ID |
VARCHAR |
No |
|
|
|
This item contains the subscriber patient Id of a coverage and will be used to associate patients with linked premium billing accounts for EHI. |
|
|